{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:56:19Z","timestamp":1790654179277,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":162,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Eczema (atopic dermatitis; AD) is a very common itchy skin condition affecting 1 in 5 children and up to 1 in 10 adults worldwide. The skin of eczema sufferers is prone to redness, irritation and dryness because it does not form an effective barrier, i.e. the ability of the skin to stop irritants, allergens and microorganisms getting into the body. Skin barrier dysfunction is a hallmark of AD. The regular and liberal (600\u2009g\/week for an adult) use of emollients is recommended for all patients with eczema), even between episodes of itching and redness, to soften and soothe the skin. In England alone, almost 9\u2009million prescriptions for emollient creams were issued in 2018, at a cost of over \u00a350\u2009million. Despite this widespread use, relatively little is known about how commonly prescribed emollient creams affect the skin's barrier, and thus the role of moisturizers in AD development and progression remains unclear. We set out to compare three different types of emollient cream and a no-treatment control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare the barrier-strengthening properties of a new moisturizer containing urea and glycerol (urea\u2013glycerol cream; UGC), with those of a glycerol-containing moisturizer (glycerol cream; GC), a simple paraffin cream (PC) with no humectant, and a no-treatment control (NTC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an observer-blinded prospective Phase 2 within-subject multilateral single-centre randomized controlled trial in adults with AD (Clinical Trials #NCT03901144). The intervention involved 4\u2009weeks of treatment, twice daily, with the three products applied to one of four areas on the forearms the (the fourth area was the untreated control, randomized allocation). Skin properties [dryness, transepidermal water loss (TEWL), hydration and natural moisturizing factor (NMF) levels] were assessed before, during and after treatment to see what happened to the skin's barrier. The primary outcome was skin sensitivity to the irritant sodium lauryl sulfate (SLS) after treatment. We performed tests on the skin before and after treatment to see what happened to the skin's barrier.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 49 patients were randomized, completed treatment and included in the analysis. UGC significantly reduced the response to SLS as indicated by a reduction in TEWL compared with NTC (\u22129.0\u2009g\/m2\/h; 95% CI \u221212.56 to \u22125.49), with PC (\u22129.0\u2009g\/m2\/h; 95% CI \u221212.60 to \u22125.44) and with GC \u22124.2\u2009g\/m2\/h; 95% CI 7.76 to \u22120.63). Skin moisturization improved at sites treated with UGC compared with NTC and PC, and this was accompanied by concordant changes in dryness and NMF levels. Subgroup analysis suggested FLG-dependent enhancement of treatment effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study showed that not all emollient creams for eczema are equal. The simple paraffin-based emollient, which represents the most widely prescribed type of emollient cream in England, had no effect on the skin's barrier and reduced the skin's NMF. UGC markedly improved the skin's barrier and protected against irritation. GC performed better than PC, but not as well as UGC. UGC strengthened the skin barrier through a mechanism involving increased NMF levels in the skin, and imparted protection from SLS-induced irritation. By helping correct a major pathophysiological process, UGC has the potential to improve the long-term control of AD. The results show that different emollient creams have different effects on our skin, and only certain types have the ability to improve the skin's barrier and protect against irritants that trigger eczema.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ced.15141","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T17:29:52Z","timestamp":1644946192000},"page":"1154-1164","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-140X","authenticated-orcid":false,"given":"Simon G.","family":"Danby","sequence":"first","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul V.","family":"Andrew","sequence":"additional","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie N.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Statistical Services Unit University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda J.","family":"Kay","sequence":"additional","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1595-7441","authenticated-orcid":false,"given":"John","family":"Chittock","sequence":"additional","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Pinnock","sequence":"additional","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Intisar","family":"Ulhaq","sequence":"additional","affiliation":[{"name":"Sheffield Children\u2019s Hospital Sheffield Children's NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Fasth","sequence":"additional","affiliation":[{"name":"Perrigo Nordic Kista, Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Carlander","sequence":"additional","affiliation":[{"name":"Perrigo Nordic Kista, Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Holm","sequence":"additional","affiliation":[{"name":"Perrigo Nordic Kista, Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4428-2428","authenticated-orcid":false,"given":"Michael J.","family":"Cork","sequence":"additional","affiliation":[{"name":"Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Medical School Sheffield UK"},{"name":"Sheffield Children\u2019s Hospital Sheffield Children's NHS Foundation Trust Sheffield UK"},{"name":"Department of Dermatology, The Royal Hallamshire Hospital Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1111\/jdv.16892","article-title":"ETFAD\/EADV Eczema Task Force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children","volume":"34","author":"Wollenberg","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/cea.13847","article-title":"Skincare interventions in infants for preventing eczema and food allergy: a cochrane systematic review and individual participant data meta-analysis","volume":"51","author":"Kelleher","year":"2021","journal-title":"Clin Exp Allergy"},{"key":"2023022412434965400_","article-title":"Emollients and moisturisers for eczema","volume":"2","author":"Zuuren","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1034\/j.1600-0846.2001.70401.x","article-title":"Instrumental and dermatologist evaluation of the effect of glycerine and urea on dry skin in atopic dermatitis","volume":"7","author":"Loden","year":"2001","journal-title":"Skin Res Technol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1111\/bjd.14684","article-title":"A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier","volume":"175","author":"Danby","year":"2016","journal-title":"Br J Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/01.mop.0000171321.68806.bd","article-title":"Cutaneous bacterial infections in the newborn","volume":"17","author":"Larson","year":"2005","journal-title":"Curr Opin Pediatr"},{"key":"2023022412434965400_","first-page":"746","article-title":"An audit of adverse drug reactions to aqueous cream in children with atopic eczema","volume":"271","author":"Cork","year":"2003","journal-title":"Pharm J"},{"key":"2023022412434965400_","first-page":"397","article-title":"A review of patient adherence to topical therapies for treatment of atopic dermatitis","volume":"96","author":"Snyder","year":"2015","journal-title":"Cutis"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"587","DOI":"10.2340\/00015555-2051","article-title":"Comparison of moisturizing creams for the prevention of atopic dermatitis relapse: a randomized double-blind controlled multicentre clinical trial","volume":"95","author":"Akerstrom","year":"2015","journal-title":"Acta Derm Venereol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1111\/j.1468-3083.2009.03303.x","article-title":"Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial","volume":"23","author":"Wiren","year":"2009","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/j.1365-2133.2005.06989.x","article-title":"Variation in barrier impairment and inflammation of human skin as determined by sodium lauryl sulphate penetration rate","volume":"154","author":"Jongh","year":"2006","journal-title":"Br J Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/j.1365-2133.2006.07319.x","article-title":"Percutaneous penetration of sodium lauryl sulphate is increased in uninvolved skin of patients with atopic dermatitis compared with control subjects","volume":"155","author":"Jakasa","year":"2006","journal-title":"Br J Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1080\/00015550152384227","article-title":"Effect of moisturizers on skin susceptibility to irritants","volume":"81","author":"Held","year":"2001","journal-title":"Acta Derm Venereol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/000155599750011705","article-title":"Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants","volume":"79","author":"Held","year":"1999","journal-title":"Acta Derm Venereol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1600-0536.1997.tb00213.x","article-title":"Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream","volume":"36","author":"Loden","year":"1997","journal-title":"Contact Dermatitis"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1159\/000445955","article-title":"The effect of an emollient containing urea, ceramide NP, and lactate on skin barrier structure and function in older people with dry skin","volume":"29","author":"Danby","year":"2016","journal-title":"Skin Pharmacol Physiol"},{"key":"2023022412434965400_","first-page":"709","article-title":"O\/W emulsions compromise the stratum corneum barrier and improve drug penetration","volume":"58","author":"Gloor","year":"2003","journal-title":"Pharmazie"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1038\/jid.2012.42","article-title":"Urea uptake enhances barrier function and antimicrobial defense in humans by regulating epidermal gene expression","volume":"132","author":"Grether-Beck","year":"2012","journal-title":"J Invest Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1111\/j.1398-9995.2010.02540.x","article-title":"Levels of filaggrin degradation products are influenced by both filaggrin genotype and atopic dermatitis severity","volume":"66","author":"Kezic","year":"2011","journal-title":"Allergy"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1159\/000441545","article-title":"Biological variation in skin barrier function: from A (atopic dermatitis) to X (xerosis)","volume":"49","author":"Danby","year":"2016","journal-title":"Curr Probl Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jid.2017.08.037","article-title":"The effect of water hardness on surfactant deposition following washing and subsequent skin irritation in atopic dermatitis patients and healthy controls","volume":"138","author":"Danby","year":"2018","journal-title":"J Invest Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1365-2133.1996.tb07604.x","article-title":"Effect of topically applied lipids on surfactant-irritated skin","volume":"134","author":"Loden","year":"1996","journal-title":"Br J Dermatol"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1080\/09546634.2017.1325310","article-title":"Topical use of dexpanthenol: a 70th anniversary article","volume":"28","author":"Proksch","year":"2017","journal-title":"J Dermatolog Treat"},{"key":"2023022412434965400_","doi-asserted-by":"crossref","first-page":"932","DOI":"10.36849\/JDD.6312","article-title":"Racial\/ethnic variations in skin barrier: implications for skin care recommendations in skin of color","volume":"20","author":"Alexis","year":"2021","journal-title":"J Drugs Dermatol"},{"key":"2023022412434965400_","volume-title":"Prescription cost analysis England","author":"NHS Digital","year":"2018"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ced.15141","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ced.15141","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/47\/6\/1154\/49328401\/ced1154.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/47\/6\/1154\/49328401\/ced1154.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T17:09:53Z","timestamp":1726679393000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/47\/6\/1154\/6693106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,1]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,1]]},"published-print":{"date-parts":[[2022,6,1]]}},"URL":"https:\/\/doi.org\/10.1111\/ced.15141","relation":{},"ISSN":["1365-2230","0307-6938"],"issn-type":[{"value":"1365-2230","type":"electronic"},{"value":"0307-6938","type":"print"}],"subject":[],"published-other":{"date-parts":[[2022,6,1]]},"published":{"date-parts":[[2022,6,1]]},"assertion":[{"value":"2021-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}